Unscheduled Hospital Admission Following Ambulatory Gynecologic Laparoscopic Surgery

The objective of this study was to identify factors that may predict patients at risk for unscheduled admission following ambulatory gynecologic laparoscopic surgery and to identify specific complications that may be associated with unscheduled admission. Each patient admitted on an unscheduled basis was compared to 2 patients who did not require admission. Thirty-one demographic and clinical factors were evaluated by univariate analysis. Significant factors (p < 0.05) were then analyzed using multivariate stepwise logistic regression. During a 6-year period, 80 patients required unscheduled admission. This represents 4.61% of 1732 patients who underwent ambulatory gynecologic laparoscopic surgery. Factors associated with admission by multivariate analysis included (1) previous laparotomy, (2) significant medical illnesses, (3) history of pelvic inflammatory disease, (4) major operative laparoscopy, and (5) increased surgical blood loss. Sensitivity was 53.8%, specificity was 90.0%, and the overall correct rate of prediction was 77.9%. Postoperative emesis was the most common cause for unscheduled admissions and occurred in 27.1% of patients. Postoperative pain accounted for an additional 20% of admissions. Previous laparotomy, significant medical illnesses, and history of pelvic inflammatory disease are factors that cannot be altered preoperatively. Surgical blood loss, a function of the procedure, cannot be modified easily. Major operative gynecologic laparoscopic surgery is extensive and may be associated with delayed recovery. Postoperative emesis and pain management may warrant further investigation. Successful antiemetic therapy and effective control of postoperative pain have the potential to reduce unscheduled admissions by almost 50%. (J GYNECOL SURG 9:227, 1993)